TCM Care Manager - Mecklenburg

About the role

Epiphany Family Services is seeking a compassionate and detail-oriented TCM Care Manager to serve as the primary point of coordination for individuals enrolled in our Tailored Care Management (TCM) program. This role ensures the delivery of person-centered, comprehensive, and high-quality care by assessing needs, developing individualized service plans, coordinating services, and advocating for clients. The Care Manager collaborates with individuals, families, healthcare providers, and community partners to improve overall health outcomes and quality of life.

Responsibilities

• Care Management & Coordination
  • Conduct comprehensive assessments of physical, behavioral health, and social needs
  • Develop, implement, and monitor individualized care plans based on client goals
  • Coordinate services across medical, behavioral health, housing, and social service systems
  • Provide ongoing follow-up, care coordination, and health promotion
• Referrals & Resource Linkage
  • Connect individuals to appropriate community resources
  • Address Social Determinants of Health (SDOH), including housing, education, access to care, and community support
  • Empower individuals to actively manage their health and wellness
• Transitions of Care
  • Coordinate follow-up within 24 hours of hospital or emergency department discharge
  • Support individuals through life transitions (e.g., housing changes, incarceration release)
• Crisis Response
  • Identify and respond to crisis situations in accordance with agency protocols
  • Participate in on-call rotation and 24/7 crisis response as required
  • Participate in post-crisis debriefings and prevention planning
• Collaboration & Advocacy
  • Build and maintain relationships with interdisciplinary care teams and community partners
  • Advocate for equitable access to services and resources
  • Educate clients and families on available services and self-management strategies
• Documentation & Compliance
  • Maintain accurate, timely, and compliant documentation in accordance with state, federal, and program guidelines
  • Monitor client progress and adjust care plans as needed
• Quality Improvement & Additional Duties
  • Participate in team meetings, trainings, and Quality Improvement (QI) initiatives
  • Monitor utilization, outcomes, and compliance metrics
  • Perform additional duties as assigned

Requirements

• Bachelor’s degree in Social Work, Nursing, Human Services, or related field required; Master’s preferred
• Minimum of 2 years of experience in care management, case management, or care coordination
• Experience working with individuals with behavioral health conditions, chronic health needs, or social barriers

Qualified Professional (QP) Requirements – North Carolina

Candidates must meet Qualified Professional (QP) criteria in accordance with 10A NCAC 27G. To qualify, candidates must meet one of the following:

• Be a fully certified professional through the North Carolina Addictions Specialist Professional Practice Board (NCASPPB) with 4 years of full-time experience working with the MH/DD/SUD population
  • Note: CADC-R and CADC-I are not considered full certification
• Meet degree and experience requirements as follows:
  • For CADC Credential Holders
    • If no college degree: Minimum 4 years of full-time experience with MH/DD/SUD population
    • If college graduate: must meet one of the following:
      • Master’s degree in a human services field + 1 year of supervised MH/DD/SUD experience
      • Bachelor’s degree in a human services field + 2 years of supervised MH/DD/SUD experience
      • Bachelor’s degree in a non-human services field + 4 years of supervised MH/DD/SUD experience
  • Be a Substance Use Disorder Professional with equivalent supervised experience:
    • 1 year (Master’s level)
    • 2 years (Bachelor’s in human services)
    • 4 years (Bachelor’s in non-human services)

Skills & Competencies

• Strong understanding of care management principles and community resources
• Knowledge of ICD-10 coding and behavior management techniques
• Excellent communication, organizational, and problem-solving skills
• Ability to manage a caseload and prioritize effectively
• Proficiency in EHR systems and Microsoft Office
• Licensed Social Worker, Registered Nurse, or other applicable credential preferred
• Valid driver’s license and reliable transportation for community-based work

Benefits

• Medical, Dental, and Vision Insurance
• Short-Term Disability (STD) & Long-Term Disability (LTD)
• Group Life Insurance
• 80 Hours of PTO (Vacation, Sick, and Personal Time)
• Paid Holidays
• Employee Discount Program (Tickets at Work)

About Epiphany Family Services

Epiphany Family Services is committed to providing an integrated system of care to individuals from diverse backgrounds. We empower those experiencing mental health and substance use challenges with the tools needed to achieve and sustain recovery.